In the 2000 U.S. Census, 35 million Americans over 65 years of age were counted, representing 12.4% of the U.S. population. Approximately one-third of those over age 65 in the U.S., or roughly 12 million Americans, have a significant hearing loss that is sufficient to make them hearing-aid candidates. Yet, only about 20% of those who could benefit from hearing aids actually seek them out and, of those who do seek them out, only about 40-60% are satisfied with them and use their hearing aids regularly. To be successful, hearing aids must address the most common communication complaint of older adults with impaired hearing: they can hear speech, but can't understand it. This is especially true when there are competing sounds, typically other speech, in the background. Although contemporary hearing aids provide significant benefits to older adults, to restore aided speech communication to normal or near-normal performance levels and optimize the chances for success, the speech-to-noise ratio needs to be enhanced considerably. For many older adults, contemporary hearing-aid technologies are unable to enhance the speech-to-noise ratio sufficiently. An alternate approach to this problem is to train the older adult to make better use of the information in the existing speech-to-noise ratio. The present proposal continues our work on such an auditory-training approach. Specifically, we have developed an innovative lexically motivated word-based auditory-training protocol which has been demonstrated repeatedly to be efficacious under controlled laboratory conditions. Our objective is to transition this protocol from an efficacious laboratory system to an effective in-home auditory-training system for older adults. The first step in this transition is an additional laboratory study of the optimal dosing and duration of the training regimen. Concurrently, the platform for the in-home system will be developed. Finally, a clinical trial of the in-home training system will be conducted using a three-branch parallel design with control, placebo-training, and experimental-training groups. PUBLIC HEALTH RELEVANCE: The most common communication complaint of older adults with impaired hearing is that they can hear speech, but can't understand it, especially when there are competing sounds in the background. Hearing aids, to be effective for older adults, must address this common complaint and improve speech understanding. Auditory training represents one approach to supplement the benefits provided by hearing aids and the effectiveness of an in-home auditory-training method in older adults is the focus of this project.